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European Heart Journal Advance Access originally published online on December 9, 2004
European Heart Journal 2005 26(4):350-356; doi:10.1093/eurheartj/ehi064
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© The European Society of Cardiology 2004. All rights reserved. For Permissions, please e-mail: journals.permissions{at}oupjournals.org

Prognostic risk of atrial fibrillation in acute myocardial infarction complicated by left ventricular dysfunction: the OPTIMAAL experience

Mika Lehto1,*, Steven Snapinn2,{dagger}, Kenneth Dickstein3, Karl Swedberg4, Markku S. Nieminen1 on behalf of the OPTIMAAL investigators

1Division of Cardiology, Helsinki University Central Hospital, Helsinki, Finland
2Merck Research Laboratories, West Point, PA, USA
3University of Bergen, Cardiology Division, Central Hospital in Rogaland, Stavanger, Norway
4Department of Medicine, Sahlgrenska University Hospital, Göteborg, Sweden

Received 8 July 2004; revised 26 October 2004; accepted 28 October 2004; online publish-ahead-of-print 9 December 2004.

* Corresponding author. Tel: +358 9 4711; fax: +358 9 47174574. E-mail address: mika.lehto{at}fimnet.fi

Aims The present study aimed to determine the frequency and the impact on clinical outcome of atrial fibrillation (AF) in patients with acute myocardial infarction (AMI) and left ventricular dysfunction.

Methods and results In the OPTIMAAL trial, 5477 patients with AMI and signs of left ventricular dysfunction were included. At baseline, 655 patients (12%) had AF, and 345 (7.2%) developed new-onset AF during follow-up (2.7±0.9 years). Older patients, patients with history of angina and worse Killip class had and developed AF more frequently (P<0.001). Patients with AF at baseline were at increased risk relative to those without AF for mortality [adjusted hazard ratio (HR) of 1.32, P=0.001] and for stroke (HR 1.77, P<0.001). New-onset AF was associated with increased subsequent mortality for the first 30 days following randomization (HR 3.83, P<0.001) and the entire trial period (HR 1.82, P<0.001). Risk of stroke was increased for the first 30 days (HR 14.6, P<0.001) and for the whole trial period (HR 2.29, P<0.001).

Conclusion AF is frequently observed in patients with AMI complicated by heart failure. Current AF, and the development of new AF soon after AMI, is associated with increased risk of death and stroke.

Key Words: Atrial fibrillation • Acute myocardial infarction • Heart failure • Cardiovascular mortality and morbidity • Prospective randomized endpoint trial


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